whats the toughest aspect of training in psy?

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besides the ans that i will become a psycho ,any other inputs would be appreciated.

 

[strangeglove]

intern year.

you will not become psycho by going into psychiatry. you may be more attracted to this specialty if you already are a psycho, though. so, if you're not a psycho already, then you should be okay.

 

[whopper]

A lot of the problems that can add some frustration are ones that would affect all residents--not just psychiatry residents.

E.g. long hours, relationship problems 2ndary to the long hours (though psychiatry residencies tend to be easier than other fields. E.g. my program was about 60 hrs/week. Many non-psychiatric are 80+).

If you are referring to frustrations with psychiatry residency that are psychiatry specific, here were mine
1-dealing with Axis II Cluster B patients--though by my 2nd year that stopped bugging me. In fact I even enjoy treating them now because the treatment often times does not involve medication. I enjoy avoiding medications when possible.

2-medical knowledge that I spent several years working hard to learn not being used in psyche as much as the other fields. This too went away. I started seeing certain psychiatric cases that were heavily medically oriented. You'll see plenty of them in consult-liason psychiatry.

3-substance abusing patients manipulating the system--e.g. right when their welfare check is spent on cocaine, they then come to the ER complaining that they'll kill themselves.
-My frustration was that several attendings & staff just wanted to admit them, and after they were discharged, the problem just repeated itself next month. This wasn't getting the person better, it was wasting a lot of the system's money & it was about a total of 30 hrs of paperwork on the part of several people everytime these types showed up.

4-Consults that were just compelte bull--e.g. the Eagles lost a football game so we think this guy's depressed--can you prescribe an antidepressant? While I loved the medicine aspects of C/L psychiatry--over 50% of the consults I was assigned were over-reactions from the medical staff & attendings.

 

[NewmansOwn]

4-Consults that were just compelte bull--e.g. the Eagles lost a football game so we think this guy's depressed--can you prescribe an antidepressant? While I loved the medicine aspects of C/L psychiatry--over 50% of the consults I was assigned were over-reactions from the medical staff & attendings.

If you saw their offense last night, you wouldn't say it was bull.

 

[OldPsychDoc]

If you saw their offense last night, you wouldn't say it was bull.

I'd say it had a lot more to do with Da Bears' defense!

 

[Anasazi23]

Again, maybe it's because I'm becoming very paranoid as I trudge through forensic fellowship where I'm reviewing cases of "malpractice" by psych docs....

Strings of near or pseudo-suicidal patients in outpatient settings that don't want to be voluntarily admitted, and don't quite meet criteria for me to admit them involuntarily. It's just super-stressful, and even annoying in bursts.

 

[OldPsychDoc]

Again, maybe it's because I'm becoming very paranoid as I trudge through forensic fellowship where I'm reviewing cases of "malpractice" by psych docs....

Strings of near or pseudo-suicidal patients in outpatient settings that don't want to be voluntarily admitted, and don't quite meet criteria for me to admit them involuntarily. It's just super-stressful, and even annoying in bursts.

Or inpatients whose holds have expired and they're demanding to go home, the county's not supporting commitment, but you just don't trust 'em...

We spend half our time trying to convince those who WANT to stay in the hospital to get out, and the other half trying to keep those who don't want to to stay in. 🙄

 

[whopper]

Strings of near or pseudo-suicidal patients in outpatient settings that don't want to be voluntarily admitted, and don't quite meet criteria for me to admit them involuntarily. It's just super-stressful, and even annoying in bursts.

The old 3 hots & a cot or I'll kill myself? or the Borderline who is parasuicidal & managed care won't pay for them, but if you discharge them you're going to get sued if they hurt themselves.

 

[Faebinder]

Strings of near or pseudo-suicidal patients in outpatient settings that don't want to be voluntarily admitted, and don't quite meet criteria for me to admit them involuntarily. It's just super-stressful, and even annoying in bursts.

Or inpatients whose holds have expired and they're demanding to go home, the county's not supporting commitment, but you just don't trust 'em...

Seriously, those two situations are the reason we are in demand. No one else wants to deal with them. So work as usual as far as I'm concerned.

 

[BabyPsychDoc]

The old 3 hots & a cot or I'll kill myself? or the Borderline who is parasuicidal & managed care won't pay for them, but if you discharge them you're going to get sued if they hurt themselves.

hey, what is your legal position in the cases like above? here, in the UK, we are rather privileged in that we only have to demonstrate that the (para)suicidal patient does not have Axis 1 disorder of sufficient severity to make them "a danger to themselves and/or others" - and adios! They can have Axis II condition (eg, Borderline PD), but as long as there is no current AND severe Axis I co-morbid diagnosis, AND you have documented your eval in detail, you are well-protected. You accept they may well go and off themselves accidentally, but if the person turns up in ER 87th time in 10 months, each time 20-30 min after OD with 3-5 g Tylenol , both the hospital and the lawyers would support your decision to manage such pt in community.

 

[OldPsychDoc]

hey, what is your legal position in the cases like above? here, in the UK, we are rather privileged in that we only have to demonstrate that the (para)suicidal patient does not have Axis 1 disorder of sufficient severity to make them "a danger to themselves and/or others" - and adios! They can have Axis II condition (eg, Borderline PD), but as long as there is no current AND severe Axis I co-morbid diagnosis, AND you have documented your eval in detail, you are well-protected. You accept they may well go and off themselves accidentally, but if the person turns up in ER 87th time in 10 months, each time 20-30 min after OD with 3-5 g Tylenol , both the hospital and the lawyers would support your decision to manage such pt in community.

Truthfully, if you document well (and somewhat dependent on the state within the US) a situation like that is going to get dismissed in your favor before it even gets to court. The key is again, document. And did I say "Document"? I think we tend to practice more in fear of lawsuit than in the face of actual litigation. OTOH, when you're in the ED on call at 2 am, one tends to fall back on mantras like "It's easier to defend one's decision-making in the presence of a living patient", and just tell yourself, "What the heck--the hospital/county/state can eat the cost of this hospital day". 🙄

 

[Still Kickin]

On the subject of documentation in relation to evaluation for suicidality:

How to Write a Suicide Note (As in - your CHART note!)

(Although, I must say, I knew I had seen this before & did a google search for "how to write a suicide note" and got a disturbing number of hits that didn't appear to be about charting...)

I'm just posting this because I remember reading it & thinking it was interesting. Maybe some actual psychiatrists in practice out there would care to weigh in on what they think about the author's advice.